Provider Demographics
NPI:1225181076
Name:INTEGRATED RENAL CARE OF THE PACIFIC, LLC
Entity Type:Organization
Organization Name:INTEGRATED RENAL CARE OF THE PACIFIC, LLC
Other - Org Name:FMC DIALYSIS SERVICES OF PEARLRIGDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-2668
Mailing Address - Street 1:920 WINTER ST
Mailing Address - Street 2:FMCNA CKD SERVICES
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1521
Mailing Address - Country:US
Mailing Address - Phone:781-699-4160
Mailing Address - Fax:781-699-4046
Practice Address - Street 1:98-1005 MOANALUA RD
Practice Address - Street 2:STE. 420
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4777
Practice Address - Country:US
Practice Address - Phone:808-440-4800
Practice Address - Fax:808-440-4827
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-18
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI102472Medicare PIN